Document Detail


Preoperative work-up in asymptomatic patients undergoing Roux-en-Y gastric bypass: is endoscopy mandatory?
MedLine Citation:
PMID:  17059738     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: We aimed to determine before Roux-en-Y gastric bypass (RYGBP) in asymptomatic morbidly obese patients: 1) the prevalence of abnormal findings at upper gastrointestinal (UGI) endoscopy; 2) Helicobacter pylori (HP) status; 3) clinical consequences of these findings; and 4) associated costs. METHODS: We retrospectively reviewed 468 consecutive patients, excluded those with UGI symptoms, drug intake or previous UGI endoscopy/surgery, and analyzed findings in the 319 remaining patients (68%). RESULTS: There were abnormal findings in 147 patients (46%), including 54 hiatal hernias and 146 parietal (i.e. mucosal or submucosal) lesions. The most significant were 7 ulcers and 2 gastric polyposis. HP was detected (using CLO-test) in 124 patients (39%). Histopathological examination of biopsies was abnormal in 109/161 patients (68%), and disclosed mainly chronic gastritis (n=98). Abnormal findings were more frequent in HP-positive compared to HP-negative patients (94 vs 51%, P<0.001). Findings had clinical implications in only 4% of patients: delayed surgery (7 ulcers), prophylactic gastrectomy (2 gastric polyposis), unnecessary work-up (3 irrelevant/false-positive diagnoses), and inclusion in a screening program (1 Barrett's esophagus). Mean cost of complete UGI work-up was 389 euro/patient. CONCLUSION: Asymptomatic morbidly obese patients frequently harbour UGI lesions warranting UGI work-up before RYGBP. However, routine endoscopy presents drawbacks. We propose a less invasive strategy which reduces costs and limits false-positive results and the subsequent investigations that they require. In our series, it would have missed two gastric polyposis only, for which no formal recommendation has yet been issued. This strategy could be a valuable alternative to routine UGI endoscopy before RYGBP in asymptomatic patients.
Authors:
D Azagury; J M Dumonceau; P Morel; G Chassot; O Huber
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Obesity surgery     Volume:  16     ISSN:  0960-8923     ISO Abbreviation:  Obes Surg     Publication Date:  2006 Oct 
Date Detail:
Created Date:  2006-10-24     Completed Date:  2007-01-10     Revised Date:  2007-12-05    
Medline Journal Info:
Nlm Unique ID:  9106714     Medline TA:  Obes Surg     Country:  England    
Other Details:
Languages:  eng     Pagination:  1304-11     Citation Subset:  IM    
Affiliation:
Department of Digestive Surgery, Geneva University Hospitals, Geneva, Switzerland.
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MeSH Terms
Descriptor/Qualifier:
Adult
Chronic Disease
Endoscopy, Gastrointestinal / economics,  utilization*
Female
Gastric Bypass*
Gastritis / epidemiology
Helicobacter Infections / diagnosis,  economics,  epidemiology*
Helicobacter pylori
Humans
Intestines / pathology
Male
Metaplasia
Middle Aged
Obesity, Morbid / economics,  epidemiology*,  surgery
Retrospective Studies
Switzerland

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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